Healthcare Provider Details

I. General information

NPI: 1831430511
Provider Name (Legal Business Name): CAPITAL AREA HUDSON VALLEY NY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 BERNARDSTON RD
GREENFIELD MA
01301-1238
US

IV. Provider business mailing address

6 EXECUTIVE PARK DR SUITE C
CLIFTON PARK NY
12065-5601
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-3850
  • Fax: 413-773-5300
Mailing address:
  • Phone: 518-248-0240
  • Fax: 518-348-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1856165
License Number StateMA

VIII. Authorized Official

Name: DR. G STEPHEN KNOLL
Title or Position: PC PRESIDENT
Credential:
Phone: 518-371-8481